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Patient Chooses Minimally Invasive Surgery

CancerWise - October 2007

By Renee Twombly

Jimmy Pullen used to like bread around a hot dog, but he feels a little differently now. After all, a hot dog bun got caught in his throat momentarily last December. The 

Jimmy and Patricia Pullen

incident propelled him to the doctor, who discovered cancer of the esophagus.

Pullen, 67, underwent a highly advanced, minimally invasive surgery at M. D. Anderson in which his esophagus was removed with surprisingly little trauma.

He left the cancer center in June with only a few coin-sized incisions instead of the long scar that would have been the result of traditional open chest surgery.

The hot dog bun, he realizes, offered an early warning that may have helped save his life. Now he acts as a resource for others facing surgery who want to know about his rapid recovery.

Taking the less invasive route

Pullen, a chemical worker retired from a Firestone rubber plant, had begun to develop problems swallowing before the hot dog bun incident, but didn’t think much about it. After a piece of the bun temporarily stuck in his throat, he visited a gastroenterologist, who said he probably had a common age-related narrowing of the esophagus. He also told Pullen that the tube that leads from the mouth to the stomach could easily be stretched out.

But that isn’t what the doctor saw through his endoscope. Instead, he ordered a computed tomography (CT) scan, performed a needle biopsy and two days later told his patient that he had esophageal cancer.

Pullen was referred to M. D. Anderson where oncologists told him that he had advanced, stage III cancer that needed to be treated with chemotherapy and radiation therapy. If he did well, surgery might then be possible.

After his treatments ended in late April, Pullen was 35 pounds lighter. Still, his tumor responded, and his surgeon, Reza Mehran, M.D., suggested a minimally invasive esophagectomy (MIE). The procedure uses tiny laparoscopic and thoracoscopic tools to remove the esophagus and place his stomach higher into the chest.

“I thought, why not?” Pullen says. “I assumed this was a standard practice because so much surgery is now being done this way.”

But MIE is only now beginning to be used in certain hospitals, and Pullen was among the first group of patients to receive it.

The second day after his seven-hour surgery, Pullen was sitting up in the intensive care unit. “I thought I was supposed to be able to do that, but I surprised all the nurses who didn’t expect that,” he recalls with a laugh.

Dreaming of salads

After leaving the hospital for his home in Orange, Texas, Pullen received nutrition through an intravenous pump for four weeks, but he missed the real stuff so much that occasionally he would put a morsel in his mouth for a time, but not swallow it. “I longed for a hamburger,” he says. “I even thought about how good a salad tastes.”

The day he was told he could eat again, he went to a restaurant with his wife, Patricia, and one of their three sons (they have two daughters as well). He ordered a crab fondue appetizer, and life became normal again.

Depression and overeating challenge him

Pullen says he has had only two problems after surgery. The first was a depression, which descended on him the third week because he thought he wasn’t recovering fast enough. But Mehran told him on a return visit “that I was several months ahead of the game,” Pullen says. “I may be 67, but I think like I'm 37.” The depression lifted.

The other issue he has dealt with is overeating. Although his stomach is smaller, he still feels hungry. “It’s hard not to overeat,” he says. The tightness he feels around his ribcage, however, does not bother him, and he has had no pain since he left the hospital.

Pullen is walking more than a mile a day and has begun to mow the grass. Four-wheeling on the family farm will come soon, he believes. “I'm getting stronger.”

He now talks on the phone to other patients who are candidates for MIE. “I tell them you have to get your mind right before you take this on. You have to be positive and ready for the fight, and you have it keep it that way. And then you will recover, probably quicker than you realize, and feel good. Like I do.”


© 2015 The University of Texas MD Anderson Cancer Center